Infection Prevention and Control Practices Among United States Hemodialysis Facilities

From 2014 through 2019, bloodstream infection (BSI) rates among US hemodialysis patients decreased by 40%. Several national efforts to address the burden of BSIs among hemodialysis patients were introduced spanning 2015 through 2019. We aimed to compare facility-reported infection prevention and control (IPC) practices in 2015 and 2021, to identify changes in practices nationally.

Outpatient hemodialysis facilities complete the National Healthcare Safety Network (NHSN) Outpatient Dialysis Practices Survey annually. Data from the Practices Survey pertaining to IPC practices were analyzed for 2015 and 2021. Counts, percentages, and medians with interquartile ranges were calculated, as appropriate. Percentage differences or points (% points) were calculated to compare specific variables from 2015 and 2021. Greater than 5% point difference was a priori selected as possibly suggesting a meaningful change.

In 2021, 7400 facilities completed the survey, comprising 503,530 dialysis patients. In 2021 compared with 2015, >5% point change was observed for several recommended catheter care practices such as exit site care (use of chlorhexidine with alcohol for skin antisepsis [90.8% uptake, +5.9% points] and antimicrobial ointment or chlorhexidine-impregnated dressing [29.0%, +6.4% points]), and catheter hub care (alcohol for hub antisepsis [84.3%, +9.9% points]). In 2021, 49.3% of facilities used chlorhexidine-impregnated catheter caps.

Increased uptake of recommended IPC practices, and introduction of chlorhexidine-impregnated catheter caps may have contributed to decreased BSI rates among hemodialysis patients. Continued efforts are needed to increase adoption of Centers for Disease Control and Prevention (CDC)-recommended catheter exit site care practices and ensure maintenance of IPC practices with high uptake.